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Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction.

Publication ,  Journal Article
Tromp, J; Shen, L; Jhund, PS; Anand, IS; Carson, PE; Desai, AS; Granger, CB; Komajda, M; McKelvie, RS; Pfeffer, MA; Solomon, SD; Køber, L ...
Published in: J Am Coll Cardiol
August 6, 2019

BACKGROUND: Although heart failure with preserved ejection fraction (HFpEF) is considered a disease of the elderly, younger patients are not spared from this syndrome. OBJECTIVES: This study therefore investigated the associations among age, clinical characteristics, and outcomes in patients with HFpEF. METHODS: Using data on patients with left ventricular ejection fraction ≥45% from 3 large HFpEF trials (TOPCAT [Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function], I-PRESERVE [Irbesartan in Heart Failure With Preserved Systolic Function], and CHARM Preserved [Candesartan Cilexetil in Heart Failure Assessment of Reduction in Mortality and Morbidity]), patients were categorized according to age: ≤55 years (n = 522), 56 to 64 years (n = 1,679), 65 to 74 years (n = 3,405), 75 to 84 years (n = 2,464), and ≥85 years (n = 398). This study compared clinical and echocardiographic characteristics, as well as mortality and hospitalization rates, mode of death, and quality of life across age categories. RESULTS: Younger patients (age ≤55 years) with HFpEF were more often obese, nonwhite men, whereas older patients with HFpEF were more often white women with a higher prevalence of atrial fibrillation, hypertension, and chronic kidney disease (eGFR <60 ml/min/1.73 m2). Despite fewer comorbidities, younger patients had worse quality of life compared with older patients (age ≥85 years). Compared with patients age ≤55 years, patients age ≥85 years had higher mortality (hazard ratio: 6.9; 95% confidence interval: 4.2 to 11.4). However, among patients who died, sudden death was, proportionally, the most common mode of death (p < 0.001) in patients age ≤55 years. In contrast, older patients (age ≥85 years) died more often from noncardiovascular causes (34% vs. 20% in patients age ≤55 years; p < 0.001). CONCLUSIONS: Compared with the elderly, younger patients with HFpEF were less likely to be white, were more frequently obese men, and died more often of cardiovascular causes, particularly sudden death. In contrast, elderly patients with HFpEF had more comorbidities and died more often from noncardiovascular causes. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302; Irbesartan in Heart Failure With Preserved Systolic Function [I-PRESERVE]; NCT00095238; Candesartan Cilexetil in Heart Failure Assessment of Reduction in Mortality and Morbidity [CHARM Preserved]; NCT00634712).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

August 6, 2019

Volume

74

Issue

5

Start / End Page

601 / 612

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Tetrazoles
  • Systole
  • Survival Rate
  • Stroke Volume
  • Prognosis
  • Morbidity
  • Mineralocorticoid Receptor Antagonists
  • Middle Aged
  • Male
 

Citation

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Tromp, J., Shen, L., Jhund, P. S., Anand, I. S., Carson, P. E., Desai, A. S., … McMurray, J. J. V. (2019). Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol, 74(5), 601–612. https://doi.org/10.1016/j.jacc.2019.05.052
Tromp, Jasper, Li Shen, Pardeep S. Jhund, Inder S. Anand, Peter E. Carson, Akshay S. Desai, Christopher B. Granger, et al. “Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction.J Am Coll Cardiol 74, no. 5 (August 6, 2019): 601–12. https://doi.org/10.1016/j.jacc.2019.05.052.
Tromp J, Shen L, Jhund PS, Anand IS, Carson PE, Desai AS, et al. Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol. 2019 Aug 6;74(5):601–12.
Tromp, Jasper, et al. “Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction.J Am Coll Cardiol, vol. 74, no. 5, Aug. 2019, pp. 601–12. Pubmed, doi:10.1016/j.jacc.2019.05.052.
Tromp J, Shen L, Jhund PS, Anand IS, Carson PE, Desai AS, Granger CB, Komajda M, McKelvie RS, Pfeffer MA, Solomon SD, Køber L, Swedberg K, Zile MR, Pitt B, Lam CSP, McMurray JJV. Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol. 2019 Aug 6;74(5):601–612.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

August 6, 2019

Volume

74

Issue

5

Start / End Page

601 / 612

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Tetrazoles
  • Systole
  • Survival Rate
  • Stroke Volume
  • Prognosis
  • Morbidity
  • Mineralocorticoid Receptor Antagonists
  • Middle Aged
  • Male